Assessment of Left ventricular function in coronary slow flow by two-dimensional speckle tracking dobutamine stress Echocardiography

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Haidy Sherif Elhagin, Reda Biomy, Mohamed Kamal Salama, Mohamed S. Elsherbeni, Wael A. Haseeb


Dobutamine; Stress Test; Coronary slow flow; Ischemia; Echocardiography; Speckle tracking


The Coronary Slow Flow Phenomenon (CSFP) is defined as delayed distal vessel contrast opacification without any evidence of obstructive epicardial coronary artery disease. Medical literature contains conflicting data regarding the effects of CSFP on left ventricular functions assessed by conventional echocardiography or tissue Doppler imaging.

Material and methods: Patients with chronic stable angina were referred for coronary angiography from February 2022 to December 2022 at the Department of Cardiology, Faculty of Medicine, Kafrelsheikh University Hospitals. 50 patients with CSFP and 50 age-and-sex-matched controls without CSFP were enrolled in the study. CSFP was diagnosed by TIMI Frame Count (TFC). GLS of LV was measured by two-dimensional (2D) STE in addition to other conventional and tissue Doppler parameters to assess LV diastolic and systolic functions.

Results: LV GLS was lower in CSFP group patients (–15 ±2.73) compared to the control group (–17.19 ±2.54) (p=0.001). There was a statistically significant negative correlation between mean TFC and LV GLS (r=–0.33, p=0.002). LVEF by the modified Simpson method was lower in the CSFP group (57.77 ±5.66%) compared to the control group (59.29 ±3.32%) but with no statistical significance (p=0.18). Left atrial diameter LAVI was larger in the CSFP group compared to the control group (p

Conclusions: CSFP impairs LV systolic and diastolic function, using 2D speckle tracking dobutamine stress echocardiography; the most pivotal findings reveal that dynamic assessments under different dobutamine infusion rates highlighted substantial alterations in left ventricular function. Specifically, left ventricular strain (LS), strain rate during systole (LSRs), and strain rate during early diastole (LSRed) demonstrated significant differences across varying infusion rates, with notable decrements in LS and LSRs as dobutamine dosage increased.

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